The serious consequences of pancreatic fistula result from the pancreatic juice becoming activated by the bile and intestinal fluid, which will eventually corrupt the PJ anastomosis and the surrounding normal tissues. The corrosion of the vasculature will lead to lethal hemorrhage, which is the main cause of mortality after pancreaticoduodenectomy. Furthermore, pancreatin, together with the bacteria in the alimentary tract, will lead to intra-abdominal infection and abscess. To reduce the pancreatic fistula rate, several techniques have been described as alternatives to the conventional PJ anastomosis. Duct-to-mucosa sutures, binding pancreaticojejunostomy and end-to-side invaginated fashion are widely used in the current clinical setting. Some non-randomized studies showed that the duct-to-mucosa method was a relatively safe approach. However, the prospective clinical study found that in comparison with the conventional end-to-side anastomosis, duct-to-mucosa did not obviously decrease the incidence of pancreatic fistula as well as other operative complications. The Peng's binding anastomosis technique might be relatively simple to operate and have shorter operative time, but as the raw pancreatic surface is exposed to the jejunal lumen directly after the reconstruction, the activated pancreatic juice might lead to hemorrhage through vascular corrosion. Moreover, a wide or large pancreatic stump will not fit the size of the jejunal lumen, which could lead to anastomosis ischemia and leakage. The duct-to-mucosa method is not affected by the size of pancreatic remnant and the jejunal lumen. The seromuscular layer of the jejunum covers the pancreatic stump completely and will lower the incidence of postoperative hemorrhage. It was proved to be superior to invagination anastomosis in terms of anastomotic patency and function. Unfortunately, in the cases of small main pancreatic duct or normal soft pancreas, the duct-to-mucosa approach is difficult to operate and takes more surgery time, while simultaneously increasing the incidence of postoperative pancreatic fistula(POPF). Therefore, it is difficult to find a single superior strategy that applies to every case. Selecting an optimal pancreaticojejunal anastomotic method should be based on the different textures of pancreas and the various sizes of the main pancreatic duct.